Type and Location of Adenomyosis in Women with Recurrent Pregnancy Loss: A Transvaginal Ultrasonographic Assessment.

The current knowledge on adenomyosis as a risk factor for RPL is very scant. Overall 120 women were included in this retrospective observational study. They were divided in three groups each of which consisted of 40 subjects: Group 1: women with RPL who were diagnosed to have adenomyosis on transvaginal ultrasound (TVS); Group 2: patients with RPL without ultrasonographic findings of adenomyosis; Group 3: patients with ultrasound diagnosis of adenomyosis without RPL and at least one live birth pregnancy. The copresence of endometriosis was also investigated. Among women with RPL, patients with adenomyosis (Group 1) had higher number of pregnancy losses (p = 0.03) and lower age at first pregnancy loss (p = 0.03) than women without adenomyosis (Group 2). Moreover, they had more frequently primary RPL (p = 0.008). Adenomyosis of the inner myometrium was found more frequently (p = 0.04) in patients of Group 1 than in patients of Group 3 in which adenomyosis was mainly in the outer myometrium (p= 0.02). No differences were found in the severity of adenomyosis between these two groups of women. TVS findings for endometriosis were observed more frequently in women with adenomyosis without RPL (Group 3) than in the other two groups of patients. Adenomyosis can be a factor involved in RPL. Differences in adenomyosis localization are associated with different risks for RPL. Patients with RPL should be investigated for the presence of adenomyosis and also for the type and localization of the disease in the different myometrial layers.

Deep Infiltrating Endometriosis in Adolescence: Early Diagnosis and Possible Prevention of Disease Progression.

Endometriosis has a prevalence of 10% worldwide in premenopausal women. Probably, endometriosis begins early in the life of young girls, and it is commonly diagnosed later in life. The prevalence of deep infiltrating endometriosis (DIE) in adolescence is currently unknown due to diagnostic limits and underestimation of clinical symptoms. Dysmenorrhea is a common symptom in adolescents affected by DIE, often accompanied by dyspareunia and chronic acyclic pelvic pain. Ultrasonography-either performed transabdominal, transvaginal or transrectal-should be considered the first-line imaging technique despite the potential for missed diagnosis due to early-stage disease. Magnetic resonance imaging should be preferred in the case of virgo patients or when ultrasonographic exam is not accepted. Diagnostic laparoscopy is deemed acceptable in the case of suspected DIE not responding to conventional hormonal therapy. An early medical and/or surgical treatment may reduce disease progression with an immediate improvement in quality of life and fertility, but at the same time, painful symptoms may persist or even recur due to the surgery itself. The aim of this narrative review is to report the prevalence of DIE in adolescents, describe the pathogenetic theories and discuss the management in adolescent women, including the challenging road to diagnosis and the treatment alternatives.

New blood pressure cut off for preeclampsia definition: 130/80 mmHg.

The classical diagnosis of preeclampsia is usually based on the fulfillment of 3 criteria: pregnancy > 20 weeks of gestation, proteinuria (2+ on dipstick or > 300 mg/24 h) and arterial hypertension ≥ 140/90 mm Hg. The current blood pressure cut off of 140/90 mm Hg was set by the American College of Obstetrics and Gynecology (ACOG)-issued practice bulletin of 2019, the 2013 Task Force and the guidelines prompted by the International Society for the Study of Hypertension in Pregnancy (ISSHP). The evidence on which the current cut-off is based is scarce and not updated. We propose the application of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on pregnant women and defining preeclampsia with the new 130/80 blood pressure cut-off.

Influence of assisted reproductive technologies on maternal and neonatal outcomes in early preterm deliveries.

INTRODUCTION: Compared to spontaneous conception (SC), pregnancies conceived through assisted reproductive technologies (ART) carry worse pregnancy and neonatal outcomes. Evidences focused on preterm births are limited. Early preterm delivery is a critical situation for medical management and parental counselling. The aim of this study was to analyze if ART procedures influenced pregnancy and neonatal outcomes in singleton pregnancies with early preterm delivery. MATERIAL AND METHODS: This was a retrospective case control study. The population consisted of all consecutive early preterm deliveries occurred at Careggi University Hospital in Florence (Italy) between 2010 and 2017. Cases were considered patients who conceived though ART, including intra cytoplasmic sperm injection (ICSI), in vitro fertilization and embryo transfer (IVF-ET), intra uterine insemination (IUI) and ovarian stimulation. Controls were patients who conceived in the natural way. Main outcomes of the study were: birth weight, umbilical artery pH, Apgar score at 1 and 5 min, gestational age at delivery and mode of delivery. Secondary outcomes were: spontaneous preterm labor initiation, gestational diabetes mellitus, intrauterine growth restriction (IUGR), cholestasis of pregnancy, intra uterine fetal demise (IUFD), placenta previa, fetal malformations, pregnancy induced hypertensive (PIH) disorders (gestational hypertension, preeclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome) and postpartum hysterectomy. Shapiro-Wilk test was used to check the normality of the data; Mann-Whitney test was used to compare two continuous variables not-normally distributed. Multiple and binomial logistic regression analyses were used to adjust the results of the statistical analysis for potential confounding factors. The analysis for the main outcomes was performed for all deliveries and then repeated for spontaneous deliveries, separately. RESULTS: Seventy-one patients had ART and 640 SC. We found no differences in birthweight, umbilical artery pH, Apgar at 1 and 5 min and gestational age at delivery between ART and SC groups. C-section rate, placenta previa and PIH disorders were higher in the ART group. The higher prevalence of C-sections in the ART group was not statistically significant after adjusting for age and parity in the whole population but resulted significantly different when analyzing the subgroup of patients with spontaneous initiation of labor. CONCLUSIONS: Fetal outcomes seem to be equal between ART and SC in early preterm neonates ; C-section rate and pregnancy complications such as placenta previa and PIH disorders seem to be higher in the ART group. These information should be part of the family counselling in these cases. We suggest that clinicians, after management of preterm delivery had been properly addressed, should not apply different management in ART compared to SC pregnancies.